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APPLICATION FOR CERTIFIED BANKRUPTCY ASSISTANT

Please complete the application in its entirety and comply with all of its instructions. If you have any questions, please email Dorothy Clay at claydo4@yahoo.com.

I. GENERAL INFORMATION

An * indicates a required response.
IF YOU ARE RECERTIFYING SKIP TO V (RECERTIFICATION)

II. LEGAL EMPLOYMENT



III. EDUCATION/CERTIFICATIONS

List any certifications.
How long has applicant worked in the bankruptcy field?

IV. REFERENCES

Name bankruptcy attorney(s) familiar with applicant's work. The CBA Committee reserves the right to contact the attorney/employer for verification of all information provided by the applicant.

Reference 1
Reference 2

V. RECERTIFICATION

IF CERTIFICATION HAS EXPIRED WITHIN 4 YEARS OF LAST CERTIFICATION, APPLICANT IS REQUIRED TO ATTEND THE CBA PROGRAM.  NO EXAM WILL BE REQUIRED.
Are you recertifying? *

VI. COVENANTS

Please open the attached pdf to review.
Written Disclosure, Use of Program Materials and Rules & Regulations
https://fs22.formsite.com/abja/images/Application_Covenants.pdf
Acceptance and Acknowledgement *